Postpartum period

Ergonovine and metiiylergonovine may be given orally during die postpartum period to reduce die possibility of postpartum hemorrhage and to prevent relaxation of die uterus. When die patient is to receive eitiier of tiiese drains after delivery, it is important to take die blood pressure, pulse, and respiratory rate before administration. 

Laxatives may provide appropriate relief when constipation occurs during the postpartum period, when not breastfeeding and in immobile patients. Patients who are not constipated but who need to avoid straining (e.g., patients with hemorrhoids, hernia, or myocardial infarction) may benefit from stool softeners or mild laxatives. 

Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004 161 608-620. 

Postpartum women Women should receive a single booster of Tdap in the immediate postpartum period if Tdap has not been previously received. 

The onset of schizophrenic symptoms also may be associated with the menopause, and it has been suggest that estrogen protects women from schizophrenia (Hafner, et al., 1993 Seeman, 1996). Schizophrenia may be exacerbated by the menopause and during other periods when estrogens are low, such as the postpartum period. 

Fleming, A. S., Steiner, M., and Anderson, V. 1987. Hormonal and attitudinal correlates of maternal behavior during the early postpartum period. Journal of Reproductive and Infant Psychology 5 193—205. 

Female gender Prior history of depression Family history of depression Active substance abuse Recent stressful life event Poor social supports Previous suicide attempt Postpartum period Chronic medical illness... 

The symptoms of OCD generally arise in an insidious manner, though acute onset of OCD has been reported. Considerable evidence indicates that OCD, once it arises, is a chronic lifetime disorder. Even with treatment, only a small fraction of OCD sufferers experience complete remission of their symptoms. Although patients with OCD are seldom, if ever, completely symptom free, the severity of the illness fluctuates over time. During periods of heightened stress, patients with OCD are especially prone to symptomatic exacerbation. Eor example, the postpartum period,... 

There is no indication for estrogen therapy during pregnancy or during the immediate postpartum period. Estrogens are ineffective for the prevention or treatment of threatened or habitual abortion. Estrogens are not indicated for the... 

Obstetric infections include infections which occur during pregnancy, delivery and in the postpartum period, and which affect the uterus or its content. Clinical entities are amnionitis, and post partum or post-caesarean endometritis and infected abortion. Symptoms are lower abdominal pain, fever and eventually foetid amniotic fluid or lochia. 

Case Example A 28-year-old woman had been stable on lithium treatment for several years. When she became pregnant, her lithium was discontinued, and within a few weeks she was hospitalized for a severe exacerbation of mania unresponsive to CPZ in doses up to 1,200 mg/day. After a course of ECT she became euthymic and was adequately maintained on lower doses of CPZ (i.e., 50 to 100 mg/day) for the remainder of her pregnancy. The delivery and the immediate postpartum period went well, but lithium was not resumed because she opted to nurse her infant. Several weeks later, she was rehospitalized for an episode of depression, which also responded to a course of ECT. She then agreed to discontinue nursing her child and resume lithium. The patient was doing well at follow-up 1 year later. 

In pregnant women who are chronically using opioids, the fetus may become physically dependent in utero and manifest withdrawal symptoms in the early postpartum period. A daily dose as small as 6 mg of heroin (or equivalent) taken by the... 

Oxytocin is used to induce labor for conditions requiring early vaginal delivery such as Rh problems, maternal diabetes, preeclampsia, or ruptured membranes. It is also used to augment abnormal labor that is protracted or displays an arrest disorder. Oxytocin has several uses in the immediate postpartum period, including the control of uterine hemorrhage after vaginal or cesarean delivery. It is sometimes used during second-trimester abortions. 

FIGURE 14-28. Several issues of importance in assessing women s vulnerability to the onset and recurrence of depression are illustrated here. These include first onset in puberty and young adulthood premenstrual syndrome (PMS) and menstrual magnification as harbingers of future episodes or incomplete recovery states from prior episodes of depression and two periods of especially high vulnerability for first episodes of depression or for recurrence if a woman has already experienced an episode, namely, the postpartum period and the perimenopausal period. 

Taneepanichskul S, Tanprasertkul C. Use of Norplant implants in the immediate postpartum period among asymptomatic HTV-1-positive mothers, contraception 2001 64(1) 39-41. 

Karacan I, Heine W, Agnew HW, Williams RL, Webb WB, Ross JJ. Characteristics of sleep patterns during late pregnancy and the postpartum periods. Am J Obstet Gynecol 1968 101 579-586. 

Troisi A, Moles A, Panepuccia L, Lo Russo D, Palla G, Scucchi S. Serum cholesterol levels and mood symptoms in the postpartum period. Psychiatry Res 2002 109 213-219. 

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